Death Certificate Template

Death Certificate Template

Certificated Certificate of Death

NORTH CAROLINA, OFFICE OF REGISTER OF DEEDS
COUNTY OF JOHNSTON

This is to certify that Jack Johnston Broadhurst, Jr was born
July 1,1917 , died November 26,1952
in Smithfield Township,State of North Carolina,U.S.A. Cause of death
coronary thrombosis
Name of Father Jack J Broadhurst Sr Name of Mother Mabel Borden
According to Records of vital Statistics of this office
Vol 38, page 703
Witness my hand and official seal,this the 29 day of June , 1981

(OFFICIAL SEAL) ________________________________________________
REGISTER OF DEEDS, JOHNSON COUNTY, NORTH CAROLINA

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